eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpetic Whitlow: Treatment & Medication

Author: Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine
Contributor Information and Disclosures

Updated: May 27, 2009

Treatment

Emergency Department Care

  • Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief.
  • Acyclovir may be beneficial.
    • In primary infections, topical acyclovir 5% has been demonstrated to shorten the duration of symptoms and viral shedding.
    • Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence.5
  • Use antibiotic treatment only in cases complicated by bacterial superinfection.
  • Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.
  • Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial superinfection or systemic spread, and complications such as herpes encephalitis.

Medication

The main goals of treatment are to prevent oral inoculation or transmission of infection and to provide symptomatic relief.5

Antiviral agents

These agents are used to shorten the clinical course, prevent complications, prevent the development of latency and/or subsequent recurrences, decrease transmission, and eliminate established latency.


Acyclovir (Zovirax)

Topical form shortens duration of symptoms in primary infections; acts by interfering with DNA replication within the virions.
Oral acyclovir may abort recurrences if treatment is initiated immediately upon onset of symptoms; inhibits HSV-1 and HSV-2.

Adult

600-800 mg PO q4h for 7-10 d
Immunocompromised adults: 800 mg PO q4h, 5 times per d for 7-10 d
Topical: Apply 0.5-inch ribbon of ointment for a 4-in2 surface area q3h, 6 times per d for 7-14 d

Pediatric

250-600 mg/m2/dose PO 4-5 times per d for 7-10 d
Topical: Administer as in adults

Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in renal failure or when using nephrotoxic drugs

More on Herpetic Whitlow

Overview: Herpetic Whitlow
Differential Diagnoses & Workup: Herpetic Whitlow
Treatment & Medication: Herpetic Whitlow
Follow-up: Herpetic Whitlow
References
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References

  1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. [Medline].

  2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. [Medline].

  3. Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997;137(5):812-5. [Medline].

  4. El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. Mar-Apr 2005;22(2):119-21. [Medline].

  5. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87. [Medline].

  6. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].

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Further Reading

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Keywords

herpetic whitlow, herpetic infection, hand infection, herpes simplex virus, HSV-1, herpes simplex virus 2, HSV-2, infection of the hand, infection of the finger

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Contributor Information and Disclosures

Author

Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine
Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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